TUFTS UNIVERSITY

							                                                     TUFTS UNIVERSITY
                                       Request for Payment via Wire Transfer
INSTRUCTIONS:
         1.      Complete this form online providing all the information requested. (Incomplete and handwritten
                 forms will not be processed and subsequently returned to you.)
         2.      Print a copy of your completed form and forward, along with your requisition, check voucher, travel
                 form, etc. to Accounts Payable, TAB, Medford.
         3.      Please Note: All wiring instructions provided to Accounts Payable must have been provided by the
                 payee in written form (invoice, company letterhead, email from payee). Treasury will not process
                 wire requests without documentation that the payee provided the wiring instructions.

 Form prepared by:                                                           Telephone No.:                              Date:
 BENEFICIARY INFORMATION:
 Who do you want to pay:
                                                              (payee name must agree with the name on the bank account to be credited )

 In what currency do you want to pay them:                                                            Amount to be paid:
 Bank account number to be credited:
                                                                     (If you are requesting payment to a European bank then you must put the IBAN# here)

 BENEFICIARY BANKING INFORMATION:
 Name of their bank:
 City:                                                                                    Country:
 Which bank identifier are you providing (see below for options)?
 Bank Identification Number:
 Is there a correspondent or intermediary bank that the funds need to go to first?                          YES             NO
 If YES, what is the Name of Intermediary Bank:
 City:                                                                                    Country:
 Which bank identifier are you providing (see below for options)?
 Bank Identification Number:

 REFERENCE INFORMATION (up to 140 characters):
 Provide the account/deptid/project/grant to be charged $25.00 wire fee
                         Account                                          DeptID                                Project/Grant



BANK IDENTIFIERS (Without the appropriate bank identifier, the wire transfer cannot be processed).
What are bank identifiers? They are a series of characters assigned by various banking systems to each bank
that identifies who they are so that when funds are flowing through the various banking systems around the
world they are able to reach their appropriate destinations. Below are the most common identifiers used:
        ABA-must be 9 digits- used for all banks in the United States.
        SWIFT BIC- must be either 8 or 11 alphanumeric characters
        CHIPS Universal Identifier (UID)-must be 6 digits
        CHIPS Participant Routing Number-must be 4 digits
        United Kingdom BSC or Sort Code- must be 6 digits

                                              ACCOUNTS PAYABLE & TREASURY USE ONLY
 A/P Review:                                                Finance Authorized Signature:
 Date Processed:                                      Amount:                                  Check Number Assigned:

 Processed by:                                              Verified by:                                               (Revised 01/2007)